Institute for Global Orthopedics and Traumatology, University of California at San Francisco, Room 3A36, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
World J Surg. 2012 Dec;36(12):2802-8. doi: 10.1007/s00268-012-1702-1.
Injuries account for a substantial portion of the world's burden of disease and require effective surgical care. Volunteer surgical teams that form partnerships with hospitals help build local surgical capacity while providing immediate care. The purpose of the present study was to evaluate the cost-effectiveness of short orthopedic surgical volunteer trips as a method of reducing the global burden of surgical disease through both surgical and educational interventions.
Data were collected from a scheduled volunteer trip to Leon, Nicaragua, in January 2011 as part of the Cooperación Ortopédica Americano Nicaraguense (COAN), a 501c3 nonprofit organization established in 2002. Costs are from the COAN provider prospective with an additional analysis to include the Nicaraguan provider variable costs. The total burden of musculoskeletal disease averted from the patients receiving surgical intervention was derived using the disability-adjusted-life-years (DALYs) framework and disability weights from the disease control priority project. The cost-effectiveness ratio was calculated by dividing the total costs by the total DALYs averted.
A total of 44.78 DALYs were averted in this study, amounting to an average of 1.49 DALYs averted per patient. The average cost per patient from the COAN provider perspective was $525.64, and from both the COAN and Nicaraguan provider perspective it was $710.97. In the base case, cost-effectiveness was $352.15 per DALY averted, which is below twice the Nicaraguan per capita gross national income ($652.40).
Volunteer orthopedic surgical trips are cost-effective in Nicaragua. Further research should be conducted with multiple trips and with different patient populations to test the generalizability of the results.
在全球疾病负担中，损伤占很大一部分，需要有效的外科治疗。与医院建立伙伴关系的志愿外科技师团队在提供即时护理的同时，帮助建立当地的外科能力。本研究的目的是评估短期骨科志愿旅行作为通过外科和教育干预减少全球外科疾病负担的一种方法的成本效益。
数据来自于 2011 年 1 月在尼加拉瓜莱昂进行的一次计划中的志愿旅行，该旅行是美国与尼加拉瓜骨科合作组织（COAN）的一部分，这是一个成立于 2002 年的 501c3 非营利组织。成本来自 COAN 提供者的预期，另外还进行了一项分析，以包括尼加拉瓜提供者的可变成本。通过使用疾病控制优先项目的残疾调整生命年（DALYs）框架和残疾权重，得出接受手术干预的患者避免的肌肉骨骼疾病总负担。成本效益比通过将总成本除以避免的总 DALYs 来计算。
本研究共避免了 44.78 个 DALYs，平均每位患者避免了 1.49 个 DALYs。从 COAN 提供者的角度来看，每位患者的平均成本为 525.64 美元，从 COAN 和尼加拉瓜提供者的角度来看，每位患者的平均成本为 710.97 美元。在基础案例中，每避免一个 DALY 的成本效益为 352.15 美元，低于尼加拉瓜人均国民总收入的两倍（652.40 美元）。
在尼加拉瓜，志愿骨科外科技师旅行具有成本效益。应该进行更多次旅行和不同患者群体的研究，以检验结果的普遍性。
